Ezy : a simpler practice for seniors

Practicing tai chi provides older adults with benefits in mental and physical health, mobility, and strength. This modified version offers a programming alternative

by K. John Fisher, Ph.D.; Fuzhong Li, Ph.D.; and Machiko Shirai, M.S.

18 The Journal on Active Aging • May June 2004 This article provides an overview of an the flow of and control body balance simplified tai chi.11 This 8-form version 8-form tai chi. This simpler practice was mechanisms through the constant follows a gradual, simple-to-difficult modified from the contemporary 24-form interplay of yin and . progression. The movement execution version by Fuzhong Li, one of the authors begins with upper-body motion of this article. The work presented in this Yin (inactivity) and yang (activity) are (involving arm, shoulder and trunk article is based on the authors’ practical opposite, but complementary, forces of movements) and minimal demands and research experiences in tai chi nature that need to be in balance for for postural control, then moves to covering two decades, and from discussions optimal functioning (e.g. male/female, forms with increasing postural with tai chi masters, specialists and static/moving, active/passive, tension/ demands involving whole body-limb practitioners in and the United relaxation, or forceful/yielding). The coordination. (To view illustrated Ezy States. dynamic relationship between yin and Tai Chi instructions, go to page 22.) yang underpins all movements of As a form of exercise, tai chi tai chi. As in all forms of tai chi, is increasingly appeals to the growing important and linked closely with the proportion of older adults that looks for Shifting body weight creates a movements (e.g. inhaling when raising alternative and convenient ways to continuous reciprocity of yin and arms and exhaling when pressing arms exercise for health. Originally developed yang states in tai chi. The resulting down). This sinks the qi to the for purposes in China more equilibrium of through (pronounced -tee-ann), or energy than 300 hundred years ago,1 this the integration of qi and controlled center located in the lower abdomen practice has been used as a traditional movement is said to sustain health, slightly below the navel. Breathing exercise to improve fitness, health and prolong life and bring about emotional during Ezy Tai Chi should be natural, longevity2 for individuals of all ages. Tai healing.8 rhythmic and full, but not forced. chi’s low-to-moderate intensity and Breaths should originate from the beneficial effects on strength, flexibility, Shown to produce health benefits, tai diaphragm, and the inhale-exhale breathing and balance3,4,5 make it chi is gaining popularity among older rhythm should comfortably coordinate especially attractive to mature adults. adults.9 Yet few tai chi programs have with the flow of movements. been modified to suit the physical and Basically, tai chi is a series of individual mental needs of this population—many Although preferably done while movements, or forms, linked together to of whom face the challenge of declining standing, Ezy Tai Chi can also be flow smoothly from one to another. physical function. In addition, little performed in a chair by participants who When performed with continuity, these attention has been paid to issues have a problem with standing or who movements involve body and trunk associated with facilitating the delivery depend on ambulatory supports (i.e. rotation, flexion and extension of the and instruction of tai chi to populations walker, cane or wheelchair). When hips and knees, weight shifting, postural of most need. To address these performed in a seated position, these control and alignment, with and problems, scientists from the Oregon movements work the full range of without arm coordination.6 Research Institute in Eugene, Oregon, motion for the arms, shoulders and have introduced a simpler version: Ezy torso. For example, individuals with Some synchronization of diaphragmatic Tai Chi. standing difficulty may still benefit by breathing and mental concentration is engaging in upper-body-based also integral to tai chi. This element is Simplified tai chi movements such as curving back arms, purported to promote harmony between Several styles of tai chi exist, some which focuses on upper limbs and trunk body and mind. So tai chi involves historic/traditional and some of more rotation, and even lower-limb training the mind, as well as the body, recent origin. Today, the yang style is movements, such as lifting legs (similar which is why it is often referred to as probably the most popular.6,10 Ezy Tai to that of standing on one leg), which “moving .”7 Chi reduces the number and complexity works on hip flexion and stable postural of the 24-form yang style1 of tai chi to alignment. In addition to the physical movement just eight forms. These movements and meditational features of its practice, contain all the natural characteristics of The Ezy Tai Chi sequence can take less tai chi is intended to cultivate qi the conventional 24-form, but with the than three minutes to complete, (pronounced chee), an internal force or advantages of a less complex movement depending on an individual’s mobility vital energy—the nature of which is not sequence for ease of performance and level. Compared to the 10-form,12 20- fully understood. According to Chinese recall. (See Table 1 on page 24 for the form,13 and the contemporary 24-form medical theory, tai chi movements allow names of these movements.) tai chi, this modified version lends itself qi to circulate throughout the body via to being adapted to underserved channels or meridians. These energy Ezy Tai Chi consists of six postures plus populations, such as those who are pathways connect organs, joints and commencing and closing forms, all muscle groups. Along meridians are derived from the contemporary 24-form points used in tai chi as foci to direct Continued on page 20

The Journal on Active Aging • May June 2004 19 Ezy Tai Chi: a simpler practice for seniors Continued from page 19 physically or functionally challenged alignment and weight centering. strength through static and moving and for whom a lengthy learning period Following this preliminary session, exercises, while addressing the need to would be problematic. The fewer, participants may move onto performing control balance over a dynamically simpler movements and shorter each single moving exercise. changing base of support. This sequence likely make the learning practice also improves balance by experience less demanding on older Moving practice increases selective involving interlimb coordination and adults—and potentially more enjoyable. attention and allows individuals to coordination between lower-extremity experience appropriate alignment for and upper-body movements. In From a teaching standpoint, instructors balance and to coordinate rotations of addition, the training may increase the of Ezy Tai Chi avoid the need to limb and trunk. During this element, balance response repertoires older adults simplify the lengthy routines of many participants perform 8–10 repetitions of can use in balance-challenging other tai chi forms. Movements from each movement under a slow, self- situations. this modified version can be taught controlled speed. After some successful and performed as single movements, or initial practice of these static and To provide preliminary evidence of the in combination (e.g. two or three moving movements, participants should efficacy and utility of Ezy Tai Chi, movements), before participants practice be ready to start linking each of the Ezy scientists at the Oregon Research them as a complete routine. As a result, Tai Chi postures in a sequential, Institute analyzed data from a subset of instructors can focus more on teaching continuous manner. Each daily session individuals in a tai chi intervention trial. For this study, the 8-form Ezy Tai basic fundamental movements, should consist of a minimum of five sets Chi was implemented and compared to including , body position, of Ezy Tai Chi, along with repeated a conventional low-stress stretching eye-hand coordination, and breathing. practice of each movement. exercise program.15 Participants were randomly assigned to one of the two All these characteristics of Ezy Tai Chi Participants may practice tai chi in a experimental conditions. These subjects are likely to encourage learners to persist high, medium or low , depending engaged in an exercise intervention in practicing these movements and on their age, physical limitations and three times per week for three months. enhance their commitment to tai chi as training purposes.11,14 With a low stance, a lifelong exercise. the body is in a semi-squatting position, Compared to the low-stress exercise with knees bent almost 90°, which control group, tai chi participants Ezy Tai Chi session format places most demand upon the large experienced significant improvements A general plan for an in-class practice muscle groups of the thighs. With a on the self-reported mental and physical session of Ezy Tai Chi may involve the high stance, the knees are bent at an health measures, activities of daily following components: a 10-minute angle of only slight discomfort. For living (IADLs), and in the physical warm-up, 25–30 minutes of practicing older adults, a high stance is performance measures of one-leg movements/postures, and a 5-minute recommended for two reasons: balance, 50-foot walking speed, and cool down. Also recommended, five- time to rise from a chair. Although minute breaks between practice sessions • It does not impose extraneous body preliminary, these results collectively allow learners to rest and interact weight on the lower extremities; and suggest Ezy Tai Chi may be potentially socially. • It facilitates both anatomic alignment as effective in enhancing functional and flexibility for posture maneuvers. ability and health status in older After their warm-up, participants in a individuals as the more complex preliminary session can practice single In contrast, the low stance imposes 24-form version. static positions. This involves holding more body weight on the legs—the each single movement listed in Table 1 knees, in particular. This stance is also Specific program benefits (see page 24) for a period of 5–10 physically demanding on the quadriceps Ezy Tai Chi is suitable as a home-based seconds. The static movement practice for older adults and others who have activity for older adults or as a has the lowest attention demand for weak lower-limb muscle strength programming option for those health postural control and fewest between- and/or physical impairment (e.g. hip and wellness organizations that serve the limbs movement coordination tasks for replacement). mature market. As a home-based beginners, making it easier to perform. exercise program, Ezy Tai Chi allows This static practice also enables the Ezy Tai Chi: health benefits older people to experience success and participants to get the idea of setting a The 8-form Ezy Tai Chi provides move toward achieving mastery in their correct posture and a sense of body training likely to improve muscle own living environment. Home practice

20 The Journal on Active Aging • May June 2004 also removes the transportation/travel Preparation of this manuscript was Resources barrier of coming to a class and allows supported by Grant No. MH 62327 from participants to work on routines in their the National Institute of Mental Health, own time, which potentially increases A video clip of the full set of Ezy Tai and in part by Grant No. AG18394 from exercise adherence. But older adults Chi forms can be viewed through the the National Institute on Aging. should first take a class from a suitably authors’ website at http://healthy qualified and experienced instructor, so References they are introduced to the initial aging.ori.org/easytaichi/eztaichi.html. modeling and understanding of the This clip shows these movements 1. China Sports. “Simplified ‘Taijiquan.’” pace, flow and transitions between , China: Foreign Language Printing being performed in both standing House, 1980 movements. and sitting positions. A training 2. Hong, Y. and Lu, Y. “Physical Activity and Health Among Older Adults in China.” manual is also available on this The modified 8-form tai chi can be Journal of Aging and Physical Activity performed at any time or place after website. To download this link and 1999;7:247–250 3. Lan, C.; Lai, J.S.; and Chen, S.Y. “Tai Chi initial training, and it requires no view the clip, you will need Chuan: An Ancient Wisdom on Exercise and special equipment, clothing or footwear. considerable broadband width. Health Promotion.” Sports Medicine Instructors can modify this activity to 2002;32:217–224 accommodate the functional level of 4. Levandoski, L.J. and Leyshon, G.A. “Tai Chi A video of Ezy 8-Form Tai Chi Exercise and the Elderly.” Clinical Kinesiology older adults, including individuals in 1990;44:39–42 wheelchairs, those with restricted (VHS or DVD format) will soon be 5. Li, J.; Hong, Y.; and Chan, K.M. “Tai Chi: levels of physical activity, and those who available from Oregon Research Physiological Characteristics and Beneficial may be recovering from injury or Effects on Health.” British Journal of Sports Institute, c/o Ms. K. Bangle, 1715 Medicine 2001;35:148–156 previously debilitating illnesses. In fact, Franklin Boulevard, Eugene OR 6. Swaim, L.; . “Mastering yang modifications can be made (in whole or style Taijiquan.” Berkeley CA: North Atlantic in part) to fit a variety of rehabilitative 97403. The cost is US$15. Checks Books, 1999 endeavors—from assisting an individual only, please. Price includes shipping 7. Reid, D. “A complete guide to Chi-Gung.” Boston MA: Shambhala Publications, 1998 who has experienced a cerebrovascular and handling. 8. Liang, S-Y. and Wu, W-C. “Tai Chi Chuan: accident (CVA) or traumatic brain 24 and 48 postures with martial injury, to working with someone with applications.” Roslindale MA: YMAA an orthopedic impairment or Publication, 1996 prevention in refereed journals. He can be 9. Yan, J.H. and Downing, J.H. “Tai Chi: An cardiorespiratory decline. Alternative Exercise Form for Seniors.” reached by phone at 541-484-2123, or by Journal of Aging and Physical Activity Most of the tai chi postures provide email at [email protected]. 1998;6:350–362 enough flexibility to allow individuals to 10. Yu, T. and Johnson, J. “T’ai Chi Fuzhong Li, Ph.D., is a research scientist fundamentals for health care professionals and perform to their potential. And the instructors: a simplified approach for simplified 8-form version is appropriate at the Oregon Research Institute in mastering T’ai Chi basics.” Madison WI: for older adults whose motor abilities Eugene, Oregon. A native of China, he Uncharted Country Publishing, 1999 may be compromised or who find has been researching the therapeutic 11. Li, F.; Fisher, K.J.; Harmer, P.; and Shirai, M. benefits of low to moderate impact physical “A Simpler 8-Form Easy Tai Chi for elderly existing tai chi forms or similar modes persons.” Journal of Aging and Physical Activity of exercise difficult or unappealing. exercise such as tai chi for more than two 2003;11:217–229 decades. He is the principal investigator of 12. Wolf, S.L.; Coogler, C.; and Xu, T. Tai chi enhances both the physical and several randomized controlled trials “Exploring the Basis for Tai Chi Chuan As a investigating the influences of tai chi on Therapeutic Exercise Approach.” Archives of mental health of people who practice it. Physical Medicine and Rehabilitation Ezy Tai Chi’s easy-to-perform, soft and various aspects of the health of older 1997;78:886–892 fluid movements make this simplified adults. He can be reached by phone at 13. Chen, S. “A Modified Tai Chi Program for form an ideal programming option for 541-484-2123, or by email at Individuals With Physical Disabilities.” [email protected]. Palaestra 2002;18(2):43–47 older adults, regardless of their exercise 14. Yang, Z. “Yang style Taijiquan.” Beijing, experience. China: Morning Glory, 1991 Machiko Shirai, M.S., has a master’s 15. Li, F.; Fisher, K.J.; Harmer, P.; Irbe, D.; K. John Fisher, Ph.D., is a behavioral degree in Gerontology and more than 15 Tearse, R.G.; and Weimer, C. “Tai Chi and years of tai chi teaching experience. She self-rated quality of sleep and daytime scientist with the Healthy Aging Group at sleepiness in older adults: A randomized the Oregon Research Institute in Eugene, learned her craft from a tai chi master in controlled trial.” Journal of the American Oregon. He has held positions as a teacher, her native Japan, and has won Olympic- Geriatrics Society (in press) instructor, professor and researcher in level awards in tai chi in the United health and physical activity for more than States and China. She is an instructor at 20 years, and has published in excess of 50 Lane Community College in Eugene, and articles on health promotion and disease at Oregon Research Institute. Continued on page 22

The Journal on Active Aging • May June 2004 21 Ezy Tai Chi: principles and practice The Form 1: The core part of tai chi training or The eight forms practice follows a set of 10 essential principles:1 Form 1: Commencing form

1. Keep the head still and upright. Pre-commencing stance: feet together 2. Focus eyes in direction of primary with both knees unlocked, arms at sides, limb. facing forward. 3. Close the mouth (tongue can touch Commencing form the roof of the mouth). Step 1: with a slight weight-shift to the 4. Body is centered and upright. right, left foot takes a half-step to the Form 2: 5. Arch the chest and slightly round left, so that the feet are at shoulder’s the back. width apart. Toes point forward and 6. Loosen tension around the waist arms hang naturally alongside the body. and hips. 7. Sink the shoulders and drop the Step 2: slowly raise both arms up, elbows. elbows unlocked, to shoulder level, 8. Extend the fingers and settle the keeping the palms facing downward. wrists. Repulse Monkey Repulse Monkey 9. Distinguish insubstantial from Transitional movement: slightly lower (right) (left) substantial (explained below). both arms while bending legs. Form 3: (left) 10. Upper and lower body follow each other. Form 2: Repulse Monkey

Based on these 10 essentials, the Step 1: from the transitional movement following training guidelines may be described above, move the right hand followed: downward in a semicircle to shoulder level with the palm facing up. The left Complete body and mind relaxation: arm remains in position, but the left Transition to Grasp Peacock’s Tail tai chi practice requires the practitioner wrist now twists slightly so that the Form 3 (Ward-off; left) to eliminate all other thoughts and to palm faces up. Shift the body weight focus on movement, breathing, gradually to the left foot as the arm relaxation, and distribution of weight. movements are being executed.

Balancing weight: tai chi emphasizes Step 2: Now push the right hand alternating one’s balance between a forward with the body weight weight-bearing (solid) leg and a non- simultaneously shifting to the right side weight-bearing (hollow) leg. In tai chi, while the left arm lowers in a downward this is referred to as the substantial and arch, passing the left hip and ending at insubstantial of weight-balancing. the shoulder level. Grasp Peacock’s Tail Grasp Peacock’s Tail (Pull back; left) (Press; left) Breathing: breathing must be smooth, Repeat these movements twice on each regular and coordinated with the side. movements. Transitional movement: the Repulse Movement continuity/flow: all Monkey form finishes up in a ball- movements are done slowly with no holding position with hands on the pauses or breaks; that is, the postures right side. should flow evenly from start to finish. Grasp Peacock’s Tail In essence, all movements are slow, (Push; left) continuous, even, circular and smooth. There should be no feeling of tightness or stiffness in the muscles or joints. Continued on page 24

22 The Journal on Active Aging • May June 2004 eight forms

Form 3: (right) Form 7:

Transition to the Grasp Peacock’s Tail Move Hands like Transition to Brush Knees and right (Ward-off; right) Moving Clouds (left) Form 7 Twist Steps (left) Form 5:

Grasp Peacock’s Tail Grasp Peacock’s Tail Transition to Fair Lady Works at Transition to the Brush Knees and (Pull back; right) (Press; right) Form 5 Shuttles (left) right Twist Steps (right) Form 8:

Grasp Peacock’s Tail Transition to the Fair Lady Works at Closing form Closing form (Push; right) right Shuttles (right) Form 4: Form 6:

Transition to Transition to Transition to Golden Cock Stands Closing form Form 4 Form 4 Form 6 on One Leg (left)

Transition to Move Hands like Golden Cock Stands Form 4 Moving Clouds (left) on One Leg (right)

The Journal on Active Aging • May June 2004 23 Ezy Tai Chi: principles and practice Continued from page 22

Form 3: Grasp Peacock’s Tail Step 2: turn torso slightly to left while Step 4: at the end of Press, extend both moving the right hand forward to hands and palms outward and forward. This form consists of four parts: almost meet the extended left hand. This completes Push. Then, pull both hands down in a curve 1. Ward-off; past the abdomen, until right hand is Repeat all four mini-forms on the right 2. Pull back; extended sideways at shoulder level with side. 3. Press; and the bend upward; the right hand 4. Push. then joins the left hand in front of the Form 4: Move Hands like Moving chest. This completes Pull back. Clouds (left side only) Step 1: from the above ball-holding position, turn the left foot away from Step 3: with the weight seated on the Step 1: from the end of Form 3, move the midline of the body (towards left (rear) right foot, pull both hands both arms (45°) to the left side and side), then turn the upper body 45° to downward to abdomen, then push simultaneously shift the weight into the the left. Move the left hand forward forward both hands with shoulders left leg. Then, move right hand in an arriving at eye level while pressing the relaxed and elbows dropped. This arc past one’s face with palm facing the right hand down obliquely to the side completes Press. body, while left hand moves downward. of the right hip with the palm facing downward. This completes Ward-off. Step 2: turn torso gradually to the left with the weight shifting onto left leg. Simultaneously, move left hand upward Table 1. with the palm facing the body, to pass Names of Ezy Tai Chi forms the left shoulder. The right hand twists and starts its downward (palm faces the body), following the direction Form Movement direction/number of the left hand. The right leg joins the of repetitions left leg.

Repeat this movement three times. 1. Commencing form Both hands rise to shoulder level 2. Curving back arms Right, left; two times each side Transitional movement: the Move (Repulse Monkey) Hands like Moving Clouds form finishes with a ball-holding position of 3. Stepping side and moving arms To the left, then to the right hands on the right side (near the hip). (Grasp Peacock’s Tail: Ward-off, Pull back, Press, Push) Form 5: Fair Lady Works at Shuttles 4. Moving hands (Move Hands Like Left side leads; three times Step 1: from the end of Form 4, step Moving Clouds) out (45° to the left) with left foot. Left 5. Diagonal strides (Fair Lady Works Left, then right hand moves upward to block (an at Shuttles) opponent) while the right hand and right palm pushes forward and outward. 6. Standing on one leg Right, then left (Golden Cock Stands on One Leg) Step 2: Now drop the right hand. Step 7. Stepping and pushing (Brush Knees Left, then right out (45° to the right). Right hand and Twist Steps) moves upward to block (an opponent) while the left hand pushes forward and 8. Closing form Both hands fall to the side, left leg outward. drawn to the right

Note. Interim transitional movements are not included. Names in the parentheses are the standard tai chi names.

24 The Journal on Active Aging • May June 2004 Research on tai chi 2. Li, J.; Hong, Y.; and Chan, K.M. “Tai Chi: Physiological Characteristics and Beneficial Effects on Health.” British Journal of Sports The therapeutic value of tai chi to the Medicine 2001;35:148–156 3. Ross, M.C. and Presswalla, J.L. “The health and well-being of older adults is Therapeutic Effects of Tai Chi for the Form 6: Golden Cock Stands on One well documented.1,2,3,4,5,6,7 Studies using Elderly.” Journal of Gerontological Nursing Leg (left and right) 1998;24:45–47 various populations have shown that tai 4. Schaller, K.J. “Tai Chi Chih: An Exercise chi training is positively associated with Option for Older Adults.” Journal of Step 1: drop the left and right hands Gerontological Nursing 1996;22:12–17 and slowly move one’s weight to the left the following: 5. Wolf, S.L.; Coogler, C.; and Xu, T. foot. Move the right arm upward and “Exploring the Basis for Tai Chi Chuan As a Therapeutic Exercise Approach.” Archives of lift the right leg (as if it were on a 8,4,9 • Postural/balance and gait stability; Physical Medicine and Rehabilitation string). The left arm is simply at the • Reductions in falls risk and fear of 1997;78:886–892 6. Wu, G. “Evaluation of the Effectiveness of side of the left thigh. 10 falling; Tai Chi for Improving Balance and Step 2: return to a standing position • Improved cardiovascular Preventing Falls in the Older Population–a Review.” Journal of the American Geriatric 11,10,12 with feet shoulder width apart, weight function; Society 2002;50:746–754 evenly balanced. Repeat Steps 1 and 2 • Muscular strength of extensors;13 7. Yan, J.H. and Downing, J.H. “Tai Chi: An Alternative Exercise Form for Seniors.” on the right foot. 14,15 • Physical functioning; Journal of Aging and Physical Activity • Reductions in tension/stress;16,17 1998;6:350–362 Form 7: Brush Knees and Twist Steps 8. Hain, T.; Fuller, L.; Weil, L., and Kotsias, J. • Enhanced movement confidence/ “Effects of T’Ai Chi on Balance.” Archives of Step 1: turn torso slowly to the right as self-efficacy;18,19 Otolaryngology, Head and Neck Surgery 1999;125:1191–1195 right hand circles upward and outward 20 • Physical self-esteem; and 9. Tse, S.K. and Bailey, D.M. “T’Ai Chi and about ear level. Arm is slightly bent and • Sense of overall well-being.21,22 Postural Control in the Well Elderly.” palm faces upward (as if holding a American Journal of Occupational Therapy violin). Left hand follows the direction 1992;46:295–300 of the right hand. Tai chi has been recommended as an 10. Wolf, S.L.; Barnbart, H.; Kutner, H.X.; McNeely, E.; Coogler, C.; Xu, T.; and important part of exercise programs to Atlanta FICSIT Group. “Reducing Frailty Step 2: turn torso to the left as left foot promote balance, prevent falls, and and Falls in Older Persons: An Investigation takes a step in a forward direction. At of Tai Chi and Computerized Balance reduce falls and fear of falling.23,24,10,6 For the same time, left hand pushes forward Training.” Journal of American Geriatrics example, a panel comprising Society 1996;44:489–497 passing knee, while right hand pushes 11. Lai, J.S.; Lan, C.; Wong, M.K.; and Teng, forward, palm facing away from body. representatives from the American S.H. “Two-Year Trends in Cardiorespiratory Repeat this for the right knee. Geriatrics Society, British Geriatrics Function Among Older Tai Chi Chuan Practitioners and Sedentary Subjects.” Society and American Academy of Journal of the American Geriatrics Society Form 8: Closing form Orthopaedic Surgeons25 recommended 1995;43:1222–1227 12. Young, D.R.; Appel, L.J.; Jee, S.H.; and Step 1: from the end of Form 7, bring that tai chi be considered for balance Miller, E.R. “The Effects of Aerobic Exercise left foot forward to place it next to the training as a preventive strategy to and T’Ai Chi on Pressure in Older People: Results of a Randomized Trial.” right foot with knees slightly bent reduce falls among the elderly. Journal of the American Geriatrics Society (unlocked). At the same time, move 1999;47:277–284 both hands upward to face level (palms 13. Lan, C.; Lai, J.S.; Chen, S.Y.; and Wong, Collectively, the existing research M.K. “Tai Chi Chuan to Improve Muscular facing body), ending with both hands provides substantial evidence of the Strength and Endurance in Elderly crossed in front of chest. Individuals: A Pilot Study.” Archives of multidimensional health benefits of tai Physical Medicine and Rehabilitation Step 2: straighten both legs. Turn wrists chi, but questions still remain regarding 2000;81:604–607 forward, so that palms now face 14. Li, F.; Harmer, P.; McAuley, E.; Duncan, optimal levels of tai chi frequency, T.E.; Duncan, S.C.; Chaumeton, N.R.; and downward; lower both hands gradually Fisher, J. “An Evaluation of the Effects of Tai duration and intensity.6 alongside the body. Look straight ahead. Chi Exercise on Physical Function Among Older Persons: a Randomized Controlled Reference References Trial.” Annals of Behavioral Medicine 2001;23(2):139–146 1. Lan, C.; Lai, J.S.; and Chen, S.Y. “Tai Chi 1. Liang, S-Y. and Wu, W-C. “Tai Chi Chuan: Chuan: An Ancient Wisdom on Exercise and 24 and 48 postures with martial applications.” Health Promotion.” Sports Medicine Roslindale MA: YMAA Publication, 1996 2002;32:217–224 Continued on page 26

The Journal on Active Aging • May June 2004 25 Ezy Tai Chi: a simpler practice for seniors Continued from page 25

15. Li, F.; Fisher, K.J.; Harmer, P.; and McAuley, 19. Li, F.; McAuley, E.; Harmer, P.; Duncan, 23. Howland, J.; Walker Peterson, E.; Lachman, E. “Delineating the Impact of Tai Chi T.E.; and Chaumeton, N.R. “Tai Chi M.E. “Falls among elderly persons.” In S.E. Training on Physical Function Among the Enhances Self-Efficacy and Exercise Behavior Levkoff, Y.K. Chee, & S. Noguchi (eds.), Elderly.” American Journal of Preventive in Older Adults.” Journal of Aging and Aging in good health: Multidisciplinary Medicine 2002;23:92–97 Physical Activity 2001;9:161–171 perspectives, pp. 221–245. New York NY: 16. Chen, W. and Sun, W.Y. “An Alternative 20. Li, F.; Harmer, P.; Duncan, T.E.; Duncan, Springer Publishing Company, 2001 Form of Exercise for Health Promotion and S.C.; and Chaumeton, N.R. “Tai Chi As a 24. Lane, J.M. and Nydick, M. “Osteoporosis: Disease Prevention for Older Adults in the Means to Enhance Self-Esteem: A Current Modes of Prevention and Community.” International Quarterly of Randomized Controlled Trial.” Journal of Treatment.” Journal of American Academy of Community Health Education Applied Gerontology 2002;21:70–89 Orthopaedic Surgeons 1999;7:19–31 1997;16:333–339 21. Kutner, N.G.; Barnhart, H.; Wolf, S.; 25. American Geriatrics Society, British 17. Jin, P. “Efficacy of Tai Chi, Brisk Walking, McNeely, E.; and Xu, T. “Self-Report Geriatrics Society, and American Academy of Meditation, and Reading in Reducing Benefits of Tai Chi Practice by Older Orthopaedic Surgeons Panel on Falls Mental and Emotional Stress.” Journal of Adults.” Journal of Gerontology: Psychological Prevention. “Guideline for the Prevention of Psychosomatic Research 1992;36:361–370 Sciences 1997;52:242–246 Falls in Older Persons.” Journal of the 18. Hartman, C.A.; Manos, T.M.; Winter, C.; 22. Li, F.; Duncan, T.E.; Duncan, S.C.; American Geriatrics Society 2001;49:664–672 Hartman, D.; Li, B.; and Smith, J.C. McAuley, E.; Chaumeton, N.R.; and “Effects of T’Ai Chi Training on Function Harmer, P. “Enhancing the Psychological and Quality of Life Indicators in Older Well-Being of Elderly Individuals Through Adults With .” Journal of Tai Chi Exercise: A Latent Growth Curve American Geriatrics Society Analysis.” Structural Equation Modeling 2000;48:1553–1559 2001;8(1):53–83

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26 The Journal on Active Aging • May June 2004